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Outlining the study design

The following are questions to be addressed by the study team as the trainer steers their thinking into designing the planned study.

What is the purpose of the study?

The answer to this question may be:

• To obtain baseline information on existing hygiene practices prior to intervention.

• To monitor the progress of hygiene-related interventions by assessing hygiene practices at this point in time.

• To assess the effectiveness of hygiene-related interventions in changing hygiene practices that had prevailed prior to intervention.

Other purposes may be added depending on the requirements of particular projects.

What types of information will be gathered?

The answer should include some detail on whether the different types of information to be gathered will be qualitative, quantitative, or a combination of both (see Chapter 2).

What is the focus of the study?

Answers to this question will help you develop statements about the Aims and Objectives of your study (see Chapter 4).

What methods and tools are appropriate?

The following general questions may be asked before choosing suitable methods/tools:

• Can we learn enough about the practice by asking individual people about it (Interviews)? Will the reported information be sufficient, or

• Can we learn more about the practice by looking for signs of the behaviour (Observations)? Will it be necessary to choose or develop an indicator to indicate that the practice has occurred?

• Can we find out the determinants of these practices by discussions in groups about them (Group Discussions)?

What are the units of analysis?

The units of analysis used and the sampling strategies applied will depend on the type of information gathered in terms of the qualitative- quantitative mix. Whether or not the study is designed to also include quantitative data will depend on the resources available. The need to define units of study or analysis such as community, household, family, has been discussed in Chapter 2. The unit of analysis you choose must reflect your decision as to which group you want to say something about. Are you interested in findings about individuals, groups, or subgroups, such as young children and their caretakers?

Which sampling strategies will be employed?

Are you and the decision makers and other users of the information generated by your study interested in what your study will show about variations among individuals or families or groups? The answer will determine the sampling strategy or strategies you adopt. There are two broad types of sampling strategies: purposeful sampling or probability sampling. In qualitative studies. purposeful sampling is more appropriate than probability sampling. but these are not mutually exclusive categories and some elements of one type of sampling may be found in the other (see "Sampling Strategies" in Chapter 4 for a detailed guide).

How will confidence in the findings be established?

It is crucial to address this question during the processes of designing and planning the study. To be effective, data quality checks need to be put in place early in the design of qualitative investigations (see "Putting in Place Data Quality Checks" in Chapter 4 for a detailed discussion of some of such checks).

When will the study be conducted? How will it be phased?

Will your study involve long-term fieldwork? How will that be phased to fit in with your other project activities? Will the study be designed as a rapid assessment exercise? Is it going to be exploratory with a fixed time frame or an open end? Time issues are discussed further in Chapter 4.

How will logistics be organized?

Practical details related to the logistics of conducting the study are important components of planning and may influence the design of the study. For example, easy access to people and records and availability of training facilities may determine the scope of your study.

How will ethical issues and matters of confidentiality be handled?

In Chapter 2, we discussed issues of ethical relevance. These will also need to be addressed as part of the study design and planning processes.

What resources will be available? What will the study cost?

See Chapter 2 and "Developing Working Hypotheses" in this chapter for guidelines on what to budget for.

Have members of the study team been allocated specific tasks?

By the end of the planning and initial training period, individual members of the study team can be allocated specific tasks, according to their demonstrated skills and/or previous responsibilities. Very often, it is found that one person may excel in doing two or more different things during the training session while another person may seem to be good at only one task. However, the same people may turn out to be the opposite when it comes to carrying out the study. Therefore, task allocations need to be tentative during planning and they should be reviewed when the study begins. Reviewing the capacity of the study team both at the beginning of the study and at regular intervals thereafter will help to identify areas where change of roles/tasks may be required.

What resources are needed?

The resources required for the initial and also for the continuing (on-the job) training may include the following:

• Resource person(s) with experience in social science research and who are familiar with water supply, sanitation, and hygiene/health education interventions.

• Designated funds to pay for the trainer(s) fees or participants' accommodation and subsistence costs, stationery and photocopying, transportation to the training site and for field visits, refreshments for group discussions, and so on.

• This handbook and other relevant teaching materials (such as those listed in Selected Reading) according to the specific needs of the study team.

• Administrative support staff to help with communications (including phone and fax where applicable), photocopying, and so on.

• Stationery (including flip charts, marker pens, notebooks, pens, pencils, glue, adhesive tape, etc.).

• Computers, if available and if required, for information management and documentation/report writing.

• Designated space for training - a school classroom or project office meeting/seminar room. A special venue is helpful: it is not a good idea to train people in their workplaces, where interruptions are possible.

• If there are field trips, then you may have to pay for the use of a vehicle and/or petrol and/or the driver's salary.

• Video films or other visual materials on the use of different methods/ tools such as those from PRA, or showing a focus group discussion in session if available; cassette recorders for interviews and/or focus group discussions to allow trainees to practice recording and listening to recorded conversations.

How much time should be allowed for training?

Training of the study team is a continuous process that begins when the team is first formed until the end of the proposed study. This can take anywhere from a few weeks (six to eight weeks) to a few months (three months). For the purposes of the application of this handbook, we have divided the training into two parts: initial training which begins at the preplanning stage, and on-the-job training which continues throughout the conduct of the study. Each project may allow varying lengths of time for each part of the training depending on the availability of time and other resources.

See Table 1 for an example from rural Tanzania where a hygiene evaluation study was conducted. The study team consisted of selected personnel from the three government ministries: Water (Maji), Health (Afya) and Social Development (Maendeleo) assisted by a (WaterAid) resident engineer and a medical anthropologist from outside who conducted the training and study coordination. The intersectoral and interdisciplinary study team was not specially formed for the study. Instead, it was a pre-existing team that had had considerable experience of fieldwork as part of the health education activities supported by WaterAid in Dodoma Region. There were four such teams in the region, one for each district, and two teams were involved in the study which covered two districts.

Training of the WaterAid, Maji, Maendeleo and Afya (WAMMA) teams who participated in the study was done in two phases. The first phase, initial involved discussions of the rationale for assessing hygiene practices. Documented references were used to inform the study teams about current research findings and reviews of relevant works in the areas of hygiene behaviour and control of diarrhoeal diseases. The F diagram (see Figure 1, Chapter 1) was used in the discussion of sanitation-related disease transmission.

TABLE 1. An Example of a Study Timetable Including an Activity Flow Chart

Part I: Preplanning and Initial Training

Days 1-12

• Meetings with project staff
• Discussion of expectations
• Discussion of study aims, objectives and expected outputs
• Visits to the selected study sites - acquisition of consent from concerned parties, including village leaders
• Commencement of initial training
• Discussion of study schedule and preparations for fieldwork

Part II(a): Fieldwork (District I)

Days l-2 (Project office)

• Resumption of training
• Study design - include choice of methods/tools

Days 3-5 (Village 1)

• Conduct of three-pile sorting. healthwalk, community mapping, historyline and seasonal calendar for illnesses
• On-site review of information

Days 6-7 (Project office)

• Interim review and write up of findings

Days 8- 10 (Village 1)

• Feedback to participants - results of historyline and mapping
• Semi-structured interviews, seasonal calendars for activities (gender-specific) and pocket chart
• Feedback to participants - results of seasonal calendar for illnesses and activities, three-pile sorting and pocket chart

Days 11-12 (Project office)

• Interview and observation notes write-up
• Overall review, summary, and discussions
• Discussion of follow-up plans

Part II(b): Fieldwork (District II)

Days 15-16 (Project office)

• Resumption of initial training
• Study design - include choice of methods

Days 17-19 (Village 2)

• Three-pile sorting, historyline, healthwalk, mapping, semi-structured interviews, seasonal calendars and focus group discussion
• On-site review of information

Days 20-21 (Project office)

• Interim review and documentation of findings

Days 22-23 (Village 2)

• Semi-structured interviews (cont.), three-pile sorting and focus group discussion
• Feedback to participants
• Slide show at village primary school
• Presentation of results to participants

Day 24 (Project office)

• Overall review, write-up of interview and observation notes
• Discussion of preliminary findings and follow-up plans

Day 25 (Project office)

• Joint meeting of two study reams, discussion of study findings and follow-up plans
• End of fieldwork celebration

This was followed by a review of the investigative and analytical methods/tools available. The methods and tools with which the WAMMA were already familiar were reviewed before any new ones were introduced. Each WAMMA team reviewed the five clusters of hygiene practices with a view to identifying those that are most relevant for their respective study communities (see Table 2, Chapter 4). The most appropriate methods and tools for assessing the relevant hygiene practices were then selected, discussed, and tried out before the team set out for the study villages.

The initial training also included a detailed discussion of a four-stage learning process: problem identification/defining the question(s), gathering information, reviewing the information, and reflecting on the results. The hygiene evaluation cycle (see Figure 2, Chapter 4) was discussed and frequently referred to throughout the study. The initial training also included trial runs of the selected methods and tools, facilitated by introducing games and role plays including those described in "Transferring Technical Know-How" in this chapter.

The total duration or initial training In this case was two weeks, a week for each team which was located in a different district considerably distant from the other. This is an example of how logistical problems can limit the amount of time allowed for initial training. However, this was not a serious problem in this case because the WAMMA teams both consisted of highly skilled individuals (including district medical officers, community development specialists and public health engineers/technicians) who had already attended related training courses together and were used to working as a team. A week's focused training for each team was thus considered sufficient.

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